I have worked with a mother post-mastectomy. She developed cancer between
her 3rd and 4th children, and had been told the chemo would cause chemical
menopause, so was surprised and concerned to become preg. 3 yrs later.  She
presented at 2 wk pp with a cut of the remaining nipple caused, essentially,
by poor position at breast.  She was self-treating for suspected mastitis
with antibiotics borrowed from a neighbor.  Her experience with cancer tx
had left her very negative about doctors and hosptitals, and it was
difficult to get her to comply with the suggestion that she needed to be
under medical supervision.  My policy has always been not to continue to
work with individuals not under medical supervision after I have provided
what I would consider emergency care.  I re-taught proper latch with a doll
as she was too sore to nurse, got her a pump until she healed, and described
some measures to speed nipple healing.  She was an experienced nursing
mother with nicely everting nipples, and 4 kids, so I told her to bottle
feed.  The breast -- even with mastitis -- pumped enough milk to totally
sustain the baby.  Whether this would be true in all case (ie mastitis) I
can't say, as a sx of mastitis frequently is reduced supply.  I followed up
with the mother by ph, and she healed nicely. Baby went back to breast no
problem, and she cont. to exclusivelty bfeed on one breast  for the 4 mon.
that I followed her progress, mostly thru the midwife, as she was mad at me
for insisting she see a doctor.  I was firm about that as mastitis can be a
result of underlying breast disease, ie cancer,

I  work with many mothers of twins and have seen several triplet mothers,
all essentially using one breast to sustain one (or more) babies. 10-12
women who have come thru my practice have fully fed babies on one breast
after unilateral weanings due to injuries sustained during lactation or for
surgical interventions (like abscesses, etc) which were diff. to heal.  All
these women have done fine, but they have needed to be careful to protect
the remaining breast from injury, bites, candida, mastitis, etc.
Anticipatory guidance is beneficial for them.

Barbara


Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html